This unannounced comprehensive inspection took place on the 21 and 22 August 2018. The inspection team consisted of two inspectors, a specialist advisor who was an Occupational Therapist and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Highcroft Hall Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Highcroft Hall accommodates up to 52 people in one adapted building comprising of three units, two of which specialise in caring for people living with dementia. Thirty-three people lived at the home at the time of our inspection visit.

At our last inspection in January 2018 we identified significant improvements were needed throughout the service. We judged the home as 'Inadequate' in two of our key questions and identified four breaches of the Health and Social Care Act 2008. Following our January 2018 inspection, the overall rating for the service was assessed as 'Inadequate' and the service therefore remained in 'special measures'. In addition, the conditions we imposed on the providers registration in relation to falls management remained in place. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame.

This inspection took place on 21 and 22 August 2018 to follow up on our previous findings. We returned on this occasion to check whether people were safe and that the provider was taking the necessary action to improve the quality of care and reducing the risks to people. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. In addition, we found that the registered provider had made significant improvements in and was complying to the conditions we imposed. We found the service was now meeting the regulations.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although previous breaches of regulations had been met and improvement made there was still risks to people that had not been consistently mitigated. People were protected from potential abuse because staff were trained to recognise and respond to safeguarding concerns. People received their medicines as prescribed. People were supported by sufficient numbers of staff. People received care and support from suitable and appropriate staff because the registered provider was committed to safe recruitment practices.

The provider and registered manager had not ensured they acted consistently in accordance with the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make decisions and give consent, appropriate best interest meetings had not consistently taken place. People had access to healthcare professionals such as doctors, dentists, chiropodists and opticians. People were supported with their dietary needs but we received mixed views from people in respect of the quality of food.

People described staff as nice and caring and confirmed their right to privacy and dignity was respected. Those people able to manage their own care were en

The inspection took place on 10 and 11 January 2018 and was unannounced. At the previous inspection on 16 August and 18 September 2017, the provider was found to be in breach of Regulations 12, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014 and was rated as Inadequate overall. At the last inspection we found significant shortfalls in the provider’s systems to assess and manage risks to people who were at risk of falls. This had left people at risk of serious injury. We found further shortfalls in the number of staff available for people and the governance systems in place.

Highcroft Hall Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Highcroft Hall accommodates a maximum of 52 people in one adapted building. At the time of the inspection there were 40 people living at the home.

There was not a registered manager in post. The previous registered manager left their role in December 2017. A new manager had been recruited and was in the process of completing their induction. They had submitted an application with us to register. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Risks to people who were at risk of falling were not identified or managed to keep people safe and this left people at risk of serious injury. Staff moving and handling practices were unsafe and people were being supported in a way that could put them at risk of harm. People had extended waits for support as there were not always sufficient numbers of staff available to support them. There were errors in the recording of medications that meant we could not evidence that medications had always been given to keep people well. Staff had been recruited safely and staff knew how to report concerns of abuse.

People who were at risk of weight loss did not have their weights or dietary intake monitored effect

This inspection took place on 16 August and 18 September 2017 and was unannounced.

Highcroft Hall is a residential home which provides care and accommodation for a maximum 52 older people and people who lived with dementia. At the time of our inspection visit, 50 people lived at home.

At our previous inspection in August 2015, the home was rated ‘Good’ in all areas. During this visit we found improvements were now required in all areas and there were breaches in relation to Safe care and treatment, Good governance and Staffing.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were not always enough staff on duty to meet people’s needs, particularly at the week-end and on the second floor of the home.

Risks associated with people’s care, in particular regarding the risk of falls were not managed well. A number of people had experienced injuries as a result of falls and training provided to staff to assist people to move safely had not always resulted in safe practice.

Risks to people’s well -being was not always identified and acted on. Systems and processes to monitor the quality and safety of service were ineffective in ensuring people were kept safe.

People and relatives told us staff were caring, but staff did not have time to deliver more individualised person-centred care.

There were planned activities for people, but there was not enough emphasis on activities which reflected the hobbies and interests of individual people. The activity worker and care staff did not have enough time available to fully meet people’s social and emotional needs.

Staff understood how to safeguard people from harm, and the provider’s recruitment process reduced the risks of employing staff unsuitable to work in the home.

People had a choice of meals and mostly enjoyed the food provided.

Medicines were managed safely, and people received healthcare which met their needs.

Staff understood the principles of the Mental Capacity Act, supported people to make informed choices, and where necessary acted in people's best interest.

People and relatives mostly felt their concerns or complaints were listened to and addressed. Complaints were managed in accordance with the provider's complaints policy and procedures.

The provider had systems in place to identify and act on poor practice; however, not all of what we saw during our inspection visit had been identified by the registered manager or provider.

You can see what action we told the provider to take at the back of the full version of the report

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspection again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months and if there is not enough improvement so there is still a rating of

We spoke with eight people out of 50 that lived at the home. We also spoke with a visiting relative, five staff and the manager. Where people were not able to clearly express their views we observed how their care was provided to them. We also looked at four people’s care records and other records that supported the running of the home.

People told us that staff showed them respect and we saw staff promote people’s privacy, dignity and independence. One person told us it was a, “Happy home, staff are good” and another said they were, “Very satisfied” with the service.

We saw people received care that people told us they needed or was recorded in their individual care plan. This meant that their health and wellbeing was promoted. Staff were aware of people’s needs.

People told us that there were times during the evening and night where there were not always enough staff available to ensure people’s safety.

We saw the home had effective systems in place to gain people’s views of the service and regularly monitor the quality of service that people received.

People told us they felt able to raise concerns and some said they had been dealt with appropriately.

Our inspection took place on 14 and 18 August 2015 and was unannounced. We last inspected the service on 25 June 2013 and we found improvements were needed to ensure that there was sufficient staff available to keep people safe. After that inspection, the provider wrote to us and told us how they were going to make improvements. We found the provider had now made these improvements to the service.

Highcroft Hall provides personal care and accommodation for up to 52 older people, some who may live with dementia. There were 49 people living at the service when we carried out our inspection.

The service had a registered manager at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe and they were treated well by staff. People were cared for in a safe way which also maintained their independence. The registered manager and staff had a good understanding of how to keep people safe and escalate any concerns appropriately. There were enough competent staff to ensure the care people received was safe and addressed their needs and wishes in a timely manner. People’s medicines were managed in a safe way.

People received care and support in a way that showed staff were kind and considerate. Staff were knowledgeable about people’s care and support needs, and were supported with appropriate training. People were supported to make their own decisions and choices by staff who understood and promoted people’s rights and worked in their best interests. People’s healthcare needs were promoted and regular appointments with healthcare professionals were maintained.

People had access to sufficient quantities of food and drink that they enjoyed, and were able to have meals or snacks at the times they wanted them. Staff provided appropriate assistance to people that needed help to eat and drink and there were systems in place to ensure people at risk of weight loss were monitored.

People felt staff were kind to them. People had developed positive working relationships with the staff who supported them. People were well cared for and staff understood what was important to them and they were satisfied with the way individual care and support was provided to them. Staff demonstrated a good knowledge of what was important for people although there was some scope to improve opportunities for some people to follow their chosen religion.

People's needs were assessed and their support plans provided staff with guidance about how they wanted their individual needs met. Staff knew how people preferred their care and support to be delivered. People participated in a range of activities and pastimes that reflected their individual interests and preferences. People knew who to speak with if they had any concerns and were confident these would be addressed.

The provider assessed and monitored the quality of the service. There were systems in place to gain people’s views on the service and these views were acted upon when shared with the provider. In addition there were systems in place to monitor the quality of the service such as a range of management audits. People and staff found the registered manager and other senior staff approachable and were able to share their views about the service with them, although some people needed encouragement to share what they saw as minor issues. Staff felt well supported and were aware of the provider’s values and vision in striving to provide good quality care.